Judith Waltz Discusses CMS’ Final Rule for Medicare Advantage Plans

Foley & Lardner LLP Partner Judith Waltz is quoted in the article, “MA Final Rule: CMS Requires Two-Midnight Rule, Puts Limits on Internal Coverage Criteria,” in the Report on Medicare Compliance, published by the Health Care Compliance Association, discussing the Center for Medicare Services (CMS) final 2024 rule on policy and technical changes to Medicare Advantage (MA) plans.

“The final rule makes clear that managed care organizations cannot avoid any of the parameters set forth in an NCD (national coverage determination) or applicable LCD (local coverage determination) to limit coverage for MA beneficiaries,” Waltz explained.

Waltz said that CMS went a step further in the preamble by asserting NCDs and LCDs govern the means of delivery in addition to the item or service to be covered.